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2.
Am J Public Health ; 111(5): 965-968, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33734834

RESUMO

Objectives. To examine rates of emergency department (ED) visits and hospitalizations among incarcerated people in Florida during a period when health care management in the state's prisons underwent transitions.Methods. We used Florida ED visit and hospital discharge data (2011-2018) to depict the trend in ED visit and hospital discharge rates among incarcerated people. We proxied incarcerated people using individuals admitted from and discharged or transferred to a court or law enforcement agency. We fitted a regression with year indicators to examine the significance of yearly changes.Results. Among incarcerated people in Florida, ED visit rates quadrupled, and hospitalization rates doubled, between 2015 and 2018, a period when no similar trends were evident in the nonincarcerated population.Public Health Implications. Increasing the amount and flexibility of payments to contractors overseeing prison health services may foster higher rates of hospital utilization among incarcerated people and higher costs, without addressing major quality of care problems. Hospitals and government agencies should transparently report on health care utilization and outcomes among incarcerated people to ensure better oversight of services for a highly vulnerable population.


Assuntos
Atenção à Saúde/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Atenção à Saúde/normas , Florida , Humanos , Prisões Locais , Alta do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas
3.
BMC Infect Dis ; 21(1): 123, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509114

RESUMO

BACKGROUND: Xpert MTB/RIF (Xpert) has been recommended by WHO as the initial diagnostic test for TB and rifampicin-resistance detection. Existing evidence regarding its uptake is limited to public health systems and corresponding resource and infrastructure challenges. It cannot be readily extended to private providers, who treat more than half of India's TB cases and demonstrate complex diagnostic behavior. METHODS: We used routine program data collected from November 2014 to April 2017 from large-scale private sector engagement pilots in Mumbai and Patna. It included diagnostic vouchers issued to approximately 150,000 patients by about 1400 providers, aggregated to 18,890 provider-month observations. We constructed three metrics to capture provider behavior with regards to adoption of Xpert and studied their longitudinal variation: (i) Uptake (ordering of test), (ii) Utilization for TB diagnosis, and (iii) Non-adherence to negative results. We estimated multivariate linear regression models to assess heterogeneity in provider behavior based on providers' prior experience and Xpert testing volumes. RESULTS: Uptake of Xpert increased considerably in both Mumbai (from 36 to 60.4%) and Patna (from 12.2 to 45.1%). However, utilization of Xpert for TB diagnosis and non-adherence to negative Xpert results did not show systematic trends over time. In regression models, cumulative number of Xpert tests ordered was significantly associated with Xpert uptake in Patna and utilization for diagnosis in Mumbai (p-value< 0.01). Uptake of Xpert and its utilization for diagnosis was predicted to be higher in high-volume providers compared to low-volume providers and this gap was predicted to widen over time. CONCLUSIONS: Private sector engagement led to substantial increase in uptake of Xpert, especially among high-volume providers, but did not show strong evidence of Xpert results being integrated with TB diagnosis. Increasing availability and affordability of a technically superior diagnostic tool may not be sufficient to fundamentally change diagnosis and treatment of TB in the private sector. Behavioral interventions, specifically aimed at, integrating Xpert results into clinical decision making of private providers may be required to impact patient-level outcomes.


Assuntos
Técnicas de Diagnóstico Molecular/estatística & dados numéricos , Mycobacterium tuberculosis/isolamento & purificação , Setor Privado/estatística & dados numéricos , Tuberculose/diagnóstico , Antibióticos Antituberculose/uso terapêutico , Farmacorresistência Bacteriana/genética , Humanos , Índia/epidemiologia , Mycobacterium tuberculosis/genética , Projetos Piloto , Padrões de Prática Médica/estatística & dados numéricos , Rifampina/uso terapêutico , Tuberculose/tratamento farmacológico
4.
Esc. Anna Nery Rev. Enferm ; 25(3): e20200145, 2021. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1154190

RESUMO

Resumo Objetivo Analisar a oferta dos cursos de graduação em saúde na modalidade de Ensino a Distância no Brasil, destacando suas principais características para Enfermagem. Método Estudo transversal baseado em dados on line de cursos de graduação em saúde a distância, criados entre 2005 e 2020. Para doze graduações em saúde, destacaram-se características da criação e distribuição do ensino a distância, enfatizando-se a situação da Enfermagem. Realizaram-se testes de significância estatística (α=5%) e mapa. Resultados Verificaram-se 431 cursos de graduação em saúde, sendo a maioria deles criados entre 2017 e 2020 (≥61,4%). Para Enfermagem, o período de maior criação foi anterior (entre 2013 e 2016; 72,7%) (p=0,001). Todos os cursos eram vinculados a instituições privadas, que ofertavam 82.000 vagas, distribuídas em 1.363 Polos por todos os estados. Verificou-se predomínio em São Paulo (23,9%) e nas cidades localizadas no interior dos estados (64,3%) (p=0,001). Conclusão e implicações para prática Houve aumento significativo de cursos de graduação em saúde no ensino a distância no Brasil. Para Enfermagem, estes se caracterizaram por oferta privada e localizada no interior dos estados. Contudo, a distribuição regional ainda é desigual, concentrando Polos nas regiões mais ricas e centrais do país, e longe das áreas com maiores necessidades de saúde.


Resumen Objetivo Analizar la oferta de estudios superiores en salud bajo la modalidad de Educación a Distancia en Brasil, destacando sus principales características para Enfermería. Método Estudio transversal a partir de datos en línea de las carreras de grado en salud a distancia, creadas entre 2005 y 2020. Para doce titulaciones de salud se destacaron características de la creación y distribución de la educación a distancia, destacando la situación de Enfermería. Se realizaron pruebas de significación estadística (α = 5%) y mapa. Resultados Se detectaron 431 carreras de grado en salud, la mayoría de las cuales se crearon entre 2017 y 2020 (≥61,4%). Para Enfermería, el período de mayor creación fue anterior (entre 2013 y 2016; 72,7%) (p = 0,001). Todos los cursos estuvieron vinculados a instituciones privadas, que ofrecieron 82.000 plazas, distribuidas en 1.363 centros en todos los estados. Se registró predominio de cursos en São Paulo (23,9%) y en ciudades del interior de los estados (64,3%) (p = 0,001). Conclusión e implicaciones para la práctica Se advierte un aumento significativo en los cursos de pregrado en salud en educación a distancia en Brasil. Para Enfermería, estos se caracterizaron por una oferta privada ubicada en el interior de los estados. Sin embargo, la distribución regional sigue siendo desigual, concentrada en las regiones más ricas y céntricas del país, y lejos de las áreas con mayores necesidades de salud.


Abstract Objective To analyze the offer of undergraduate health courses in the Distance Learning modality in Brazil, highlighting its main characteristics for Nursing. Method This is a cross-sectional study based on distance health undergraduate courses online data, created between 2005 and 2020. For twelve health degrees, characteristics of the creation and distribution of distance learning were highlighted, emphasizing Nursing courses. Statistical significance tests (α = 5%) and mapping were performed. Results There were 43 undergraduate courses in health, most of which were created between 2017 and 2020 (≥61.4%). For Nursing, most courses were created in earlier years (2013 and 2016; 72.7%) (p = 0.001). The courses were linked to private institutions, which offered 82,000 seats and are distributed in 1,363 hubs across all states. Courses predominated in São Paulo (23.9%) and non-capital cities (64.3%) (p = 0.001). Conclusion and implications for the practice There has been a significant increase in distance education in Brazil's undergraduate health courses. For Nursing, the courses were characterized by private offers located in non-capital cities. However, the regional distribution is still uneven, concentrating hubs in the country's richest and most central regions and away from areas with the greatest health needs.


Assuntos
Humanos , Educação à Distância/estatística & dados numéricos , Educação em Enfermagem , Brasil , Estudos Transversais , Setor Privado/estatística & dados numéricos , Educação à Distância/economia , Instituições de Ensino Superior
5.
S Afr Med J ; 110(8): 747-750, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880299

RESUMO

Broader policy research and debate on the issues related to the planning of National Health Insurance (NHI) in South Africa (SA) need to be complemented by case studies to examine and understand the issues that will have to be dealt with at micro and macro levels. The objective of this article is to use caesarean section (CS) as a case study to examine the health systems challenges that NHI would need to address in order to ensure sustainability. The specific objectives are to: (i) provide an overview of the key clinical considerations related to CS; (ii) assess the CS rates in the SA public and private sectors; and (iii) use a health systems framework to examine the drivers of the differences between the public and private sectors and to identify the challenges that the proposed NHI would need to address on the road to implementation.


Assuntos
Cesárea/estatística & dados numéricos , Programas Nacionais de Saúde , Feminino , Planejamento em Saúde , Humanos , Gravidez , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , África do Sul
6.
Ann Glob Health ; 86(1): 100, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32864352

RESUMO

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde/organização & administração , Unidades de Terapia Intensiva/provisão & distribuição , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Índice de Gravidade de Doença
7.
Rev. esp. nutr. comunitaria ; 26(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-200755

RESUMO

FUNDAMENTOS: La lactancia materna (LM) es la forma natural de alimentación de los lactantes y niños pequeños y ha mostrado tener múltiples beneficios para la salud de las madres y los lactantes. Este artículo pretende describir la metodología usada en un estudio para la estimación de la prevalencia de LM durante el primer año de vida en hijo/as de mujeres que dan a luz en una clínica privada de Bizkaia e identificar factores relacionados con la LM. MÉTODOS: Estudio observacional, descriptivo, longitudinal y prospectivo, en una muestra aleatoria seleccionada de septiembre del 2016 a agosto del 2017. Tras el reclutamiento se hizo un seguimiento de 1 año de duración. La recogida de datos se realizó a partir de la historia clínica mediante cinco entrevistas (presenciales y telefónicas). Se recogieron datos socio-demográficos, biosanitarios, obstétricos, perinatales, tipo de alimentación y factores relacionados. RESULTADOS: La metodología utilizada permitió obtener el tamaño muestral estimado necesario, con un bajo porcentaje de mujeres que no desearon participar y un alto porcentaje de adherencia. De las 453 mujeres contactadas inicialmente, 87 no desearon participar en el estudio completo, de éstas 23 fueron excluidas por optar por lactancia artificial, 60 accedieron a realizar una encuesta a los 6 meses y 4 indicaron el tipo de alimentación, pero rehusaron ser contactadas. De las otras 366 mujeres que participaron, se perdieron 42 casos, (11,47%). CONCLUSIONES: La estrategia de seguimiento permitió una alta participación. La aproximación a las mujeres que no desearon participar en todas las fases del estudio puede ser de interés para visualizar el sesgo que pudieran suponer las no participantes


BACKGROUND: Breastfeeding (BF) is the natural way of feeding infants and young children and has been shown to have multiple health benefits for mothers and infants. This article aims to describe the methodology used in a study to estimate the prevalence of BF during the first year of life in children of women who give birth in a private clinic in Bizkaia and to identify factors related to BF. METHODS: Observational, descriptive, longitudinal and prospective study in a selected random sample from September 2016 to August 2017. After recruitment, a 1-year follow-up was carried out. Data collection was performed from the medical history through five interviews (face-to-face and telephone). Sociodemographic, biosanitary, obstetric, perinatal data, type of diet and related factors were collected. RESULTS: The methodology used allowed obtaining the necessary estimated sample size, with a low percentage of women who refused to participate and a high percentage of adherence. Of the 453 women initially contacted, 87 did not wish to participate in the full study, of these 23 were excluded for opting for artificial feeding, 60 agreed to conduct a survey at 6 months and 4 indicated the type of diet, but refused to be contacted. Of the other 366 women who participated, 42 cases were lost (11.47%). CONCLUSIONS: The follow-up strategy allowed high participation. The approach to women who refused to participate in all phases of the study may be of interest to visualize the bias that nonparticipants could suppose


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Aleitamento Materno/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Nutrição do Lactente , Estudos Prospectivos , Setor Privado/estatística & dados numéricos , Necessidades Nutricionais/fisiologia
8.
BMC Public Health ; 20(1): 1163, 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711487

RESUMO

BACKGROUND: The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. METHODS: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes, and CRDs were assessed using the Service Availability and Readiness Assessment manual of the World Health Organization. Health facilities were categorized into public and private facilities. RESULTS: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (ß = 2.87, 95%CI: 2.42-3.39), diabetes (ß =3.02, 95%CI: 2.03-4.49), and CRDs (ß = 15.95, 95%CI: 4.61-55.13) at private facilities were higher than the public facilities. Health facilities located in the hills had a higher readiness index for CVDs (ß = 1.99, 95%CI: 1.02-1.39). Service readiness for CVDs (ß = 1.13, 95%CI: 1.04-1.23) and diabetes (ß = 1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease-related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, province 2 (ß = 0.83, 95%CI: 0.73-0.95) had lower, and province 4 (ß =1.24, 95%CI: 1.07-1.43) and province 5 (ß =1.17, 95%CI: 1.02-1.34) had higher readiness index for CVDs. CONCLUSION: This study found sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness scores for CVDs, diabetes, and CRDs. There is an urgent need for policy reform to improve the health services for NCDs, particularly in public facilities.


Assuntos
Doenças Cardiovasculares/terapia , Diabetes Mellitus/terapia , Instalações de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Doenças não Transmissíveis/terapia , Doenças Respiratórias/terapia , Recursos em Saúde , Inquéritos Epidemiológicos , Humanos , Nepal , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Transtornos Respiratórios/terapia , População Rural , Inquéritos e Questionários , População Urbana , Organização Mundial da Saúde
9.
Proc Natl Acad Sci U S A ; 117(29): 16898-16907, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32631989

RESUMO

Although the Flint, Michigan, water crisis renewed concerns about lead (Pb) in city drinking water, little attention has been paid to Pb in private wells, which provide drinking water for 13% of the US population. This study evaluates the risk of Pb exposure in children in households relying on private wells. It is based on a curated dataset of blood Pb records from 59,483 North Carolina children matched with household water source information. We analyze the dataset for statistical associations between children's blood Pb and household drinking water source. The analysis shows that children in homes relying on private wells have 25% increased odds (95% CI 6.2 to 48%, P < 0.01) of elevated blood Pb, compared with children in houses served by a community water system that is regulated under the Safe Drinking Water Act. This increased Pb exposure is likely a result of corrosion of household plumbing and well components, because homes relying on private wells rarely treat their water to prevent corrosion. In contrast, corrosion control is required in regulated community water systems. These findings highlight the need for targeted outreach to prevent Pb exposure for the 42.5 million Americans depending on private wells for their drinking water.


Assuntos
Água Potável/normas , Intoxicação do Sistema Nervoso por Chumbo na Infância/epidemiologia , Chumbo/sangue , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Poços de Água , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , North Carolina , Purificação da Água/economia , Purificação da Água/estatística & dados numéricos
10.
BMC Public Health ; 20(1): 1053, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32620159

RESUMO

BACKGROUND: Access to sexual and reproductive health services continues to be a public health concern in Kenya, Tanzania, Uganda and Zambia: use of modern contraceptives is low, and unmet family planning needs and maternal mortality remain high. This study is an assessment of the availability, affordability and stock-outs of essential sexual and reproductive health commodities (SRHC) in these countries to inform interventions to improve access. METHODS: The study consisted of an adaptation of the World Health Organization/Health Action International methodology, Measuring Medicine Prices, Availability, Affordability and Price Components. Price, availability and stock-out data was collected in July 2019 for over fifty lowest-priced SRHC from public, private and private not-for-profit health facilities in Kenya (n = 221), Tanzania (n = 373), Uganda (n = 146) and Zambia (n = 245). Affordability was calculated using the wage of a lowest-paid government worker. Accessibility was illustrated by combining the availability (≥ 80%) and affordability (less than 1 day's wage) measures. RESULTS: Overall availability of SRHC was low at less than 50% in all sectors, areas and countries, with highest mean availability found in Kenyan public facilities (46.6%). Stock-outs were common; the average number of stock-out days per month ranged from 3 days in Kenya's private and private not-for-profit sectors, to 12 days in Zambia's public sector. In the public sectors of Kenya, Uganda and Zambia, as well as in Zambia's private not-for-profit sector, all SRHC were free for the patient. In the other sectors unaffordability ranged from 2 to 9 SRHC being unaffordable, with magnesium sulphate being especially unaffordable in the countries. Accessibility was low across the countries, with Kenya's and Zambia's public sectors having six SRHC that met the accessibility threshold, while the private sector of Uganda had only one SRHC meeting the threshold. CONCLUSIONS: Accessibility of SRHC remains a challenge. Low availability of SRHC in the public sector is compounded by regular stock-outs, forcing patients to seek care in other sectors where there are availability and affordability challenges. Health system strengthening is needed to ensure access, and these findings should be used by national governments to identify the gaps and shortcomings in their supply chains.


Assuntos
Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/estatística & dados numéricos , África Oriental , África Austral , Medicamentos Essenciais/provisão & distribuição , Instalações de Saúde , Humanos , Quênia , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Organização Mundial da Saúde
11.
Cad Saude Publica ; 36(6): e00115320, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32578805

RESUMO

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribuição , Pneumonia Viral/epidemiologia , Ventiladores Mecânicos/provisão & distribuição , Brasil/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
13.
PLoS One ; 15(4): e0231792, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298356

RESUMO

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.


Assuntos
Disparidades nos Níveis de Saúde , Classe Social , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Emprego , Feminino , Finlândia/epidemiologia , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Sistema de Registros , Fatores Socioeconômicos
14.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31911477

RESUMO

BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.


Assuntos
Children's Health Insurance Program/normas , Medicaid/normas , Setor Privado/normas , Setor Público/normas , Seguro de Saúde Baseado em Valor , Adolescente , Criança , Pré-Escolar , Children's Health Insurance Program/estatística & dados numéricos , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Estados Unidos , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
15.
MMWR Morb Mortal Wkly Rep ; 69(3): 72-76, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971934

RESUMO

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Seguro Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Florida , Humanos , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado/estatística & dados numéricos , Estados Unidos , Adulto Jovem
16.
Ann Otol Rhinol Laryngol ; 129(4): 369-375, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31752501

RESUMO

OBJECTIVE: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). METHODS: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. RESULTS: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. CONCLUSIONS: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. LEVEL OF EVIDENCE: 2c.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Otolaringologia , Otorrinolaringopatias , Procedimentos Cirúrgicos Otorrinolaringológicos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Encaminhamento e Consulta , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/normas , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento , Estados Unidos/epidemiologia
17.
Health Policy Plan ; 35(2): 133-141, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31713608

RESUMO

While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President's Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79-19.23, P = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136-4.518, P = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709-14.38, P < 0.001), and PFP facilities were also more likely to discontinue HIV outreach following transition (OR = 3.029, 1.325-6.925; P = 0.011). PNFP facilities' loss of supervision may require that public sector supervision be extended to them. Reduced HIV clinical care in PFPs, primarily HIV testing and counselling, increases burdens on public facilities. Prior PFP clients who preferred the confidentiality and service of private facilities may opt to forgo HIV testing altogether. Donors and governments should consider the roles and responses of PNFPs and PFPs when transitioning donor-funded health programs.


Assuntos
Financiamento Governamental/tendências , Infecções por HIV , Instalações de Saúde/estatística & dados numéricos , Propriedade , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Atenção à Saúde/organização & administração , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Instalações de Saúde/tendências , Humanos , Uganda
18.
BMJ Qual Saf ; 29(1): 19-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31171710

RESUMO

BACKGROUND: Improved hospital care is needed to reduce newborn mortality in low/middle-income countries (LMIC). Nurses are essential to the delivery of safe and effective care, but nurse shortages and high patient workloads may result in missed care. We aimed to examine nursing care delivered to sick newborns and identify missed care using direct observational methods. METHODS: A cross-sectional study using direct-observational methods for 216 newborns admitted in six health facilities in Nairobi, Kenya, was used to determine which tasks were completed. We report the frequency of tasks done and develop a nursing care index (NCI), an unweighted summary score of nursing tasks done for each baby, to explore how task completion is related to organisational and newborn characteristics. RESULTS: Nursing tasks most commonly completed were handing over between shifts (97%), checking and where necessary changing diapers (96%). Tasks with lowest completion rates included nursing review of newborns (38%) and assessment of babies on phototherapy (15%). Overall the mean NCI was 60% (95% CI 58% to 62%), at least 80% of tasks were completed for only 14% of babies. Private sector facilities had a median ratio of babies to nurses of 3, with a maximum of 7 babies per nurse. In the public sector, the median ratio was 19 babies and a maximum exceeding 25 babies per nurse. In exploratory multivariable analyses, ratios of ≥12 babies per nurse were associated with a 24-point reduction in the mean NCI compared with ratios of ≤3 babies per nurse. CONCLUSION: A significant proportion of nursing care is missed with potentially serious effects on patient safety and outcomes in this LMIC setting. Given that nurses caring for fewer babies on average performed more of the expected tasks, addressing nursing is key to ensuring delivery of essential aspects of care as part of improving quality and safety.


Assuntos
Mortalidade Infantil/tendências , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento , Humanos , Lactente , Recém-Nascido , Quênia/epidemiologia , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde
19.
Pan Afr Med J ; 37: 389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33796202

RESUMO

Introduction: as COVID-19 pandemic is rapidly evolving, there is a whole reorganization in hospitals to concentrate more resources to face the crisis. The purpose of this study is to evaluate the impact of COVID-19 disease on urological activity in Tunisia. To assess the differences in the management of urological conditions between the private and the public field. Methods: a survey was addressed to all certified urologists working in Tunisia in both the public and private sectors (n=194) using the national database of active urologists available and updated. We either called them or looked them up through email or social media. The form was open from March the 28th to April the 3rd. Results were obtained via spreadsheet and analysed using SPSS 23.0. Results: one hundred and twenty urologists have filled in the form. Consultations at the outpatient office were restricted to urgent cases in 66% (n=79). Telemedicine was more used by urologists in private than in public fields p=0.03. Urologists in private sector followed more the sterilization protocol of the hospital/clinic and used more disposable materials whenever possible p=0.011. Elective surgical activity has completely stopped in 85% of the responders (n=102). Elective surgery requiring transfusion or intensive care unit was performed in 38% (n=46) and 26% (n=31) if there was a risk of disease progression. Benign Prostate Hyperplasia (BPH) surgery was more performed as usual in private sector than in public sector p=0.012. It was the only condition managed differently between both sectors. Conclusion: the drop of the urological activity is essential in order to give relevant stakeholders room to act efficiently against the spread of the virus. The context of the pandemic and the hospital´s condition must be taken into consideration without compromising the patient´s outcome.


Assuntos
COVID-19 , Doenças Urológicas/terapia , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Setor Privado/estatística & dados numéricos , Hiperplasia Prostática/cirurgia , Setor Público/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Tunísia , Doenças Urológicas/fisiopatologia
20.
J. Phys. Educ. (Maringá) ; 31: e3143, 2020. graf
Artigo em Português | LILACS | ID: biblio-1134742

RESUMO

RESUMO Esta pesquisa documental objetivou apresentar considerações do cenário da expansão da Educação Física no contexto do ensino superior brasileiro, com foco em seus principaisdesdobramentos para a área. Para tanto, utilizamos dados das Sinopses Estatísticas do Censo de Ensino Superior, que foram interpretados à luz dos conceitos de Pierre Bourdieu e Ulrich Beck. Os resultados indicaram que, no lastro da expansão, ocorreu a criação e abertura de novos cursos de Educação Física, apresentando umincrementobastante considerável(874%), entre 1991-2015. A expansão se deu, especialmente, pelo setor privado, responsável pelo maior crescimento (1.381%). Isso traz à tona efeitos colaterais que têm implicado em um conjunto de desafios para a Educação Física no país.


ABSTRACT This documentary research aimed to present considerations on the scenario of the expansion of Physical Education in the context of Brazilian higher education, focusing, on its main developments for the area. For this, we used data from the Statistical Synopses of the Higher Education Census, which were interpreted in light of the concepts of Pierre Bourdieu and Ulrich Beck. The results indicated that, on the basis of the expansion, there was the creation and opening of new Physical Education courses, presenting a considerable increase (874%),between 1991-2015. The expansion was mainly due to the private sector, which accounted for the highest growth (1,381%). This brings up side effects that have implied a set of challenges forPhysical Education in the country.


Assuntos
Educação Física e Treinamento/estatística & dados numéricos , Educação Superior , Setor Privado/estatística & dados numéricos , Instituições de Ensino Superior , Mercado de Trabalho , Capacitação Profissional
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